| Detail | For this role |
|---|---|
| Department | Insurance |
| Level | Manager |
| Reports to | Head of Claims |
| Direct reports | Claims Executive, Health Claims Analyst, Claims Investigator |
| Experience | 6 to 10 years in claims with some team handling |
Claims Manager job description template
Copy this job description, replace the text in square brackets and post it on your careers page or a job portal.
Job title: Claims Manager
Department: Insurance
Reports to: Head of Claims
Location: [City], [office, branch or site]
About the role
A Claims Manager runs a claims team for a region or product line, approving claims within authority and driving fast, fair settlement. They allocate claims, decide the harder cases, manage surveyors and investigators, and control turnaround and leakage. The role reports to the Head of Claims. A good claims manager settles genuine claims quickly, keeps repudiation fair and well documented, catches fraud and leakage, keeps customers satisfied at claim time, and runs a team that customers and the business can rely on when a loss happens.
Key responsibilities
- Allocate claims across the team and decide the harder cases within authority.
- Drive fast, fair settlement of genuine claims within the promised turnaround.
- Approve claim payments within the authority limits set by the head of claims.
- Manage surveyors and investigators on field assessment and fraud checks.
- Keep every repudiation fair, well reasoned and properly documented for review and dispute.
- Control claim leakage through checks on assessment and billing.
- Handle escalated and disputed claims and grievance cases that the team cannot close.
- Coordinate with hospitals, garages, third party administrators and reinsurers.
- Track team turnaround, settlement ratio and quality and act on gaps.
- Report claims performance and fraud findings to the head of claims.
Requirements
- Graduate in any stream, insurance qualification an advantage
- Strong knowledge of claims and policy terms
- Associate of the Insurance Institute is an advantage
- 6 to 10 years in claims with some team handling
KRAs and KPIs for a Claims Manager
Key result areas for the appraisal form, each with a KPI you can measure every month or quarter.
| Key result area | How to measure it |
|---|---|
| Turnaround | Team claims settled within the promised turnaround above target |
| Settlement quality | Claims passing quality audit above the agreed level |
| Leakage control | Claim leakage on the team book reduced against target |
| Repudiation fairness | Repudiations upheld on review above the agreed level |
| Customer satisfaction | Claim experience satisfaction above the agreed benchmark |
| Grievances | Claim grievances kept below the agreed level |
Skills and tools
Tools used day to day: Claims management system, Fraud analytics tools, MS Excel, Third party administrator portals, Grievance systems.
Reporting line and career path
Next roles: Head of Claims, Regional Claims Head, Operations Manager
Interview questions for a Claims Manager
- How do you settle genuine claims fast while catching the doubtful ones?
- How do you keep a repudiation fair and defensible?
- How do you control leakage on assessment and billing?
- How do you handle a disputed claim heading to the ombudsman?
- How do you manage surveyors and investigators in the field?
- How do you keep customers satisfied at their claim moment?
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What does a Claims Manager do?
A Claims Manager runs a claims team for a region or product line. They allocate claims, decide harder cases, approve payments within authority and drive fast, fair settlement. They manage surveyors and investigators, keep repudiation fair, control leakage and handle disputes, keeping customers satisfied at claim time.
What is claim leakage?
Claim leakage is money an insurer pays out beyond what it should, through over assessment, inflated bills, fraud or process errors. A Claims Manager controls leakage with careful assessment, billing checks, surveys and investigation, so genuine claims are paid fairly without the insurer overpaying.
What skills does a Claims Manager need?
The role needs strong claims assessment and policy interpretation, sound settlement judgement, and firm fraud and leakage control. Add team management, vendor coordination with hospitals and garages, dispute handling, and the fairness and communication to serve customers well at a difficult moment.